Archive for April, 2014

Total U.S. healthcare spending increased from $27B in 1960 to $2,593B in 2010, according to a new infographic from The Advisory Board Company.

This infographic also outlines other healthcare costs, provider profits, Medicare enrollment, the rise of healthcare issues in America and much more.

Want to know how else has healthcare changed? Healthcare Innovation in Action: 19 Transformative Trends examines a set of pioneering efforts supporting the industry’s seismic shift from a volume-based culture to one rewarding value and patient-centeredness. Dozens of adaptations are explored in the 40-page resource, which delivers succinct descriptions of programs that are transforming healthcare delivery.

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Having established a firm foundation by providing over two decades of patient-centered care, the medical home model is poised for a makeover, expanding into medical neighborhoods and opening the door to specialists’ enhanced role in care coordinationtwo new metrics documented in the seventh comprehensive Patient-Centered Medical Home (PCMH) survey by the Healthcare Intelligence Network (HIN).

The annual percentage of respondents implementing the medical home model continues to rise, with a high of 58 percent reporting PCMH adoption, up from 52 percent in 2012, when the survey was last conducted.

The percentage of respondents with at least a fifth of patients assigned to medical homes more than doubled in the last two years, from 27 to 50 percent.

Today’s medical home is especially welcoming to Medicaid beneficiaries, who were targeted by only 3 percent of medical homes in 2012 but now are included in 37 percent of respondents’ patient-centered approaches.

Prepared to take their medical homes to the next level of care in the year to come, almost half—48 percent—have joined or expect to join a medical home neighborhood, defined by TransforMED&#8480 as “a strong foundation of transformed primary care practices aligned with health systems and specialists to ensure that care is maximally coordinated and managed.”

At the same time, 37 percent of 2014 respondents identified practice transformation, or the process of adopting the attributes of the patient-centered medical home model, as the most formidable challenge of medical home creation.

In new metrics from this year’s survey, nearly half of respondents (46 percent) include specialists in their patient-centered medical homes.

With an eye toward care coordination, the inclusion of case managers in medical homes jumped from 56 percent in 2012 to 76 percent in 2014.

Today’s medical homes are a little more crowded, with three-quarters of respondents reporting 21 or more physicians participating, up from 58 percent in 2012.

Undaunted by recent studies to the contrary, all 2014 respondents with medical homes believe the model can reduce cost and improve care delivery.

With healthcare and technology both evolving at a rapid pace, hospitals must transform their outdated IT systems to meet reform requirements or they could face government penalties.

Nineteen percent of hospitals indicated their top IT priority was to ensure their electronic health records (EHRs) were fully functional, according to a new infographic from Innotas. This infographic also identifies potential penalties, other top hospital priorities, barriers to implementing IT and ways to create efficiency.

Learn more about healthcare IT, telehealth and remote patient monitoring in 2014 Healthcare Benchmarks: Remote Patient Monitoring. This 40-page report delivers a comprehensive set of metrics on current practices in and ramifications of remote monitoring for care management of chronic illness, the frail elderly and remote populations.

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Selecting the right practice for embedded case managers, and then getting physicians to embrace the concept, are key to successfully embedding case managers, say two thought leaders, Irene Zolotorofe, RN, MS, MSN, administrative director of clinical operations at Bon Secours Health System, and Randall Krakauer, MD, national Medicare medical director for Aetna. Here, they discuss how to best implement these steps.

Question: How did you select practices for embedding of case managers, and what were the first steps in preparing the practice?

Response: (Irene Zolotorofe) They were chosen primarily at the recommendation of some of our operations directors; also, we began with the physicians who are absolutely willing to go ‘medical home,’ that are excited about this model of care. We like to go into a practice where they are motivated to do that type of transition with their patient population.

Physicians are the key; as a physician group expresses interest, we work with them first, since they are key to getting a whole team going. We work hand in hand with the physicians and then the practice managers, and then we bring the process down to the rest of the staff. It takes us about three months.

Question: What marketing strategy is employed to encourage the physician groups to collaborate and embrace the concept of embedding health plan case managers in their practices?

Response: (Dr. Randall Krakauer) What doesn’t always work well is to start with ‘I’m here to help you.’ It is a matter of meeting with your physicians and discussing some of your mutual goals and mutual interests. We focus on those aspects of the equation in which we have common interests: quality of care, doing a better job for our members, your patients. We focus on areas in which we have the opportunity to work together. We show them what we have accomplished in the areas of care management on our own. We can show them at this point, since we’re not new to the game now, some results that we have achieved with other physician partners. And we initiate a discussion on how we can support each other, how we can work together to meet our mutual goals and how we can both benefit from this process.

And with a little bit of time and effort in a great many cases, some great things can happen as a result of such discussions.

On April 1, 2014, President Obama signed a law that included the delay of ICD-10 implementation until at least October 1, 2015. Fifty-eight percent of respondents to the Deloitte Center for Health Solutions Live from the Center Webcast Poll expressed disappointment because their organizations wanted the shift to occur as scheduled, according to a new infographic from Deloitte.

This infographic also provides responses from approximately 1,250 healthcare industry professionals regarding optimal ICD-10 scenarios, areas most impacted by the delay and actions that will be taken in response to the delay.

How should your organization be preparing for ICD-10? Learn more in A Best Practice Roadmap to ICD-10 Readiness. This 24-page report documents the process BCBSM has established to resolve discrepancies between ICD-9 and ICD-10 codes, a milestone that has allowed the payor to complete its version of the General Equivalence Mappings (GEMs) — referred to as the Blue GEM Encyclopedia.

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Just as there are guidelines for identifying individuals most likely to benefit from remote monitoring, healthcare organizations must also choose remote monitoring vendor partners with care, advises Gail Miller, vice president of telephonic clinical operations in Humana’s care management organization, Humana Cares/SeniorBridge, who shared lessons gleaned from vendor selection for Humana’s nine separate pilots of remote patient monitoring.

I want to share how Humana chose the partners that we work with in these programs, because there are so many potential vendors to work with in the remote monitoring space. We had been evaluating companies off and on for about a year. We ended up doing a request for information (RFI) process with the top 25 we had identified internally. They weren’t necessarily the biggest vendors or the companies with the strongest balance sheet, but rather those that met the different capability criteria we were looking for and possessed the flexibility and creativity to work with us.

Some think that it’s a good idea to warn people when you’re going to be working with a large entity like Humana, so that the companies we choose are prepared to deal with our procurement and legal processes, and understand it will take some resources on their side. Since the change to the HIPAA rule in 2013 there iss more downstream liability, so we require additional business liability insurance, and our business information agreements are quite stiff. All of those things must be worked through before we can work with a vendor.

We were also looking for companies that could be easily scalable. You could have a great piece of equipment, but if it’s going to take ten months or a year to procure another thousand, that’s not going to work for us because we have to be thinking on a national basis. We also were looking for vendors willing to work with members with various home situations. We did not want to exclude anybody from our pilot.

For example, some of the equipment we looked at would only run if there were broadband in the home. We needed someone to put some type of device that they could plug in, that would help boost them or create a 4G or 3G network wherever they were. We needed to adapt to the different home situations that our individuals lived in.

Then, the equipment had to be senior friendly. We learned a lesson from a great study with Intel about three years ago. The results had some positives and some negatives, but one thing we learned was that the size of the equipment was important. At that time, the piece of equipment we were using weighed about 37 pounds. Because of the frail nature of some of our members, we had to hire an intermediary to do setup and delivery and then package it up and send it back afterward. It created a lot of extra cost and a little more confusion trying to arrange those deliveries and pickups.

One thing that we are dedicated to doing this time is making sure that whatever equipment we had in the home that we could manage it easily, and that hopefully the senior themselves or their caregiver would be able to set it up.

Consumers typically pay significantly less for in-network providers and more for out-of-network providers. Furthermore, approximately one in 10 Americans goes out of network for care, according to a new infographic from Excellus BCBS.

This infographic also provides comparative examples of the different costs for in-network and out-of-network procedures, as well as how choosing a health plan and provider can affect these costs.

Learn more about health plans and coverage in AIS’s Health Insurance Exchange Directory and Factbook. The new health insurance exchange marketplaces, public and private, will have a profound impact on the under- and uninsured, and will permanently alter the way health insurance is bought and sold. This resource is the definitive health industry guide to insurance exchange implementation and stakeholder strategies.

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America spends 2.5 times more on healthcare than other developed nations, despite using it less than these other nations, according to a new infographic from Vitals.

This infographic also shows specific price tags for healthcare procedures and tests, as well as results and life expectancy in America versus other countries.

Looking to drive value-based reimbursement without sacrificing quality of care? In Driving Value-Based Reimbursement with Integrated Care Models, Julie Schilz, director of care delivery transformation for WellPoint, and Terry McGeeney, MD, MBA, director of BDC Advisors, share their visions for this emerging care experience, from structuring incentives and reimbursement to reward high-quality and efficient care to identifying and engaging specialists in a medical home neighborhood.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Patients are 30 percent more likely to enroll in care management during or immediately after an acute event if they are contacted directly and introduced to a program and services, as opposed to being contacted via telephonic outreach, says Colin LeClair, executive director of ACO for Monarch HealthCare, which was a top performer in year one of the CMS Pioneer ACO program.

Through trial and error we found three opportunities to identify opportunities to yield patient engagement. First, getting the principal caregivers’ endorsement or that of the physician staff was by far the most effective means of earning the patients’ trust and getting them actively engaged. If we can say to a patient that ‘your physician has asked us to speak to you’, we get a ‘yes’ from the patient 80 to 90 percent of the time.

The second most effective means of enrolling patients in our care management program is during or immediately after an acute event. The idea is to catch them in the hospital if you can  immediately after they are admitted  and introduce them to the accountable care organization (ACO), our services, and what we can do to help them stay out of the hospital in the future. We found that patients are 30 percent more likely to enroll in care management during or immediately after an acute event, versus the cold telephonic outreach alternative. But this approach requires partnerships with hospitalists or with other hospital staff to notify you of those admissions because we don’t receive those from care management services in real-time data.

And finally, we find that patients are also somewhat receptive to care management services following a new diagnosis and we’re looking for those markers in the claims data as we receive it.

Download this FREE report for data on the top clinical targets of healthcare case managers; the top means of identifying and stratifying individuals for case management; and the most common locations of embedded or colocated case managers.